Abstract
The paper will focus on both the social and medical aspects of life in China. China is the fourth largest country in the world, yet it constantly rates in the lower end of modernized countries in terms of healthcare. This paper will explain how the lifestyle and the environment are putting the common person in China at risk for health problems. The main reasons for China’s health risks include a large amount of air pollution, high smoking rates, and problems with the water supply. These issues explain the high instances of lung-related disorders, such as COPD. The problems in China explain why their average lifespan is lower than other developed countries, like the United States. Also, this paper will explain the shortcomings of Chinese healthcare and which groups of people are at risk because of these shortcomings.
China is a highly modernized and massive country. It has one of the highest populations in the world and is commonly associated among the world’s superpowers, alongside the United States and Russia. However, China has many issues due to high pollution and an incredibly large population. This puts the population at risk for numerous healthcare related problems, such as respiratory disorders among countless other issues. China also has a huge drop off in quality of care between urban and rural areas. This leads to the more rural areas having worse healthcare compared to the rest of the country. Healthcare is primarily a business in China, so those who cannot afford it do not receive it. These major factors can play a huge role in the reason why China’s healthcare is much more porous than other developed countries, like Japan and the United States.
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The country of China lies in eastern Asia and is ranked the world’s fourth largest country, behind Russia, Canada, and the United States(Holtz, 2017). Although China is ranked the world’s fourth largest country, it still has one of the world’s lowest average incomes for its citizens. The population of China in two thousand and twelve was one point thirty-nine billion people, but in two-thousand eighteen, the population has risen to one point four billion people. The ratio of men to women is uneven, with 1.33 males to one female, or thirty-four million more males than females in the country (Denyer & Gowen, 2018). The reason behind this lopsided ratio is China’s “one child per family” rule that was effective from nineteen seventy-nine until two thousand and five (Denyer & Gowen, 2018). This rule states that a family in China could only have one child. This led to an abundance of female infants being killed in order to keep their family’s name alive. The infant mortality rate in the country of China is sixteen deaths per one thousand live births. The life expectancy of males is seventy-four years of age; whereas, females live to about seventy-seven years of age.
China may be the world’s fourth largest country in area, but they have much higher mortality rates when they are compared to other developed countries, including the United States. For example, the life expectancy of males in China is seventy-four years old, and for females, it is seventy-seven years old. Whereas in Japan, which is a developed country, the life expectancy is eighty years old for males and eighty-seven years old for females. The infant mortality rate in China is sixteen deaths per one thousand live births, but Japan has an infant mortality rate of only two point thirteen deaths per one thousand live births. For the population of China, road traffic accidents kill twenty-one-point three people out of one hundred thousand annually, which is more than in any other country in the world. One of the largest contributors to China’s high mortality rate compared to other countries is the limited income of its residents. This low revenue means that many of China’s residents are not able to afford healthcare for treatments of accidents or birth complications.
Many environmental factors, such as air pollution, water pollution, hazardous waste, deforestation, and soil erosion problems similarly play a role in the lower life expectancy in China. Air pollution is the principal public concern in China, with statistics stating that it caused nearly one to two million premature deaths, which accounts for twenty percent of the global air pollution deaths (Holtz, 2017). In rural, and some urban areas of China, they use what is known as biomass fuel and coal for cooking and heating houses, which leads to indoor pollution. Outdoor pollution is mostly from coal combustion, which damages China’s air, water, and agriculture. Along with coal combustion, there is carbon dioxide, smog, and traffic pollution that are all related to high rates of respiratory infections and chronic illness. Cigarette smoke is another environmental risk factor, due to the fact that China is the number one country to produce and market cigarettes. It has over three hundred and fifty million smokers, which is equivalent to one-third of the population.
Another major environmental issue in China is its water supply. Water in China is too polluted for human consumption. There was a chemical accident that leaked a carcinogenic agent called Benzene into the Huangpu River and killed thousands of pigs (Lallanilla, 2013). If the water killed thousands of pigs, imagine what it would do to humans. There are reports that more than half of the water in China is so polluted that it cannot be treated for drinking, and one-quarter of it is not even fit for industrial use (Lallanilla, 2013). In developed countries, air pollution is still a concern, along with indoor pollution. There are concerns of breathing in mold, chemicals, second-hand smoke from cigarettes, and even radiation. Impure water is not as harmful because it can be treated to remove toxins, making the water safe to drink or to swim in. The difference between the environmental risk factors for developing and developed countries is having the funds to be able to treat health issues, along with having adequate healthcare workers who are trained in their field. However, there are several aspects of Chinese culture that have negative effects on both the environment and its population’s health.
The cultural and lifestyle decisions of the Chinese people lead to a rise in certain healthcare issues. Cigarette smoking is a widely accepted practice in China. Smoking can have negative effects on both the physiological and environmental aspects of Chinese society. Smoking puts humans at increased risk of developing pulmonary tuberculosis (TB), lung cancer and, chronic obstructive pulmonary disease (COPD). Obesity has increased in China over the past few years, which has put the population at risk for cardiovascular disease. Not only does cardiovascular disease result from obesity, but so does Type 2 diabetes, hypertension, cancer, osteoarthritis, and gallbladder disease. Another health risk factor is HIV/AIDS. China is at an increased risk of contracting HIV because the people know dreadfully little about sexual practices and prevention methods. In developed countries, smoking puts the population at increased health risks for COPD, and lung cancer as well. In the United States, a developed country, there is still an increase in health risks for cardiovascular disease due to obesity. Risk factors from obesity include stroke, hypertension, diabetes mellitus, cancer, and skeletal system disorders. However, unlike China, these developed countries handle the health risks better, in the sense that they have more money, established hospitals, and enough health care personnel, whereas China has limited income, outdated equipment, and limited healthcare professionals. There is even a large disparity between rural and urban healthcare in China due to the difference in affluence.
The access to healthcare in China is different for rural and urban areas. The urban areas are considered wealthier than the rural ones. Most of China’s population reside in rural areas. There is a system where civilians must record whether they live in rural or urban areas, which helps prevent the migration of people from rural to urban areas. There are one point nine million doctors and one point four million nurses in China, with only one-third of the doctors and nurses having a college-level education or higher. The rest of the doctors and nurses only have a junior college or high school level of education. The mainstream of the advanced educated healthcare workers can be found in the urban areas, rather than the rural ones, which causes a great disparity in the quantity and quality of healthcare providers in the two areas (Holtz, 2017). There are also health inequalities between the ethnic majority Han population and the minorities. The Han are the dominant ethnic group of China, compromising ninety-one-point six percent, while the minorities only compromise eight-point four percent, making a total of one hundred and fourteen million people between the two ethnic groups. The minority groups have significantly lower general health and nutritional status than the Han ethnic group.
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Urban areas in China are more populated with healthcare workers and people who can more readily afford access to healthcare. Healthcare is not a right, and it is only given if one can afford it. There are elderly people living in urban areas who cannot afford to pay for healthcare, so they do not receive it. There was a study conducted, where sixty-one percent of elderly people living in urban areas reported health issues, and fourteen percent reported the main reason that they did not seek help was due to financial difficulties (Jotheeswaran, 2015). The elderly population has less money the older they get, and the price of healthcare gets more expensive the longer they stay in a hospital. The care the elderly receive is poor, but there is nothing they can do because they have no money or jobs. For support in their old age, the elderly people rely on their children, along with traditional Chinese medicines, including acupuncture, herbal treatments, acupressure, cupping of the skin and, moxibustion (Holtz, 2017). These medicines are especially active in treating minor illnesses and chronic diseases, and they produce far fewer side effects. The healthcare for children is expected to increase and have the infant mortality rates decrease to twelve deaths for every one-thousand live births (China Aims to Improve Child Healthcare, Education, 2015). China plans to achieve this goal by implementing measures to prevent and treat birth defects and provide free pre-gestational tests.
Healthcare is not cheap, and some countries may not have access to insurance programs, leaving the residents to pay out of pocket for healthcare, which can get exceedingly pricey. China reverted to a self-pay system for clinics and hospitalization, but it is extremely expensive. To stay in the hospital, it costs fifty percent more than one’s annual income. In many areas in China, they now have access to healthcare on a sliding scale, which is based on one’s ability to pay. There is also an insurance company, called Urban Employee Basic Health Insurance (UEBHI), and all employees must participate. This insurance covers twenty percent of the population, with the employer paying six percent, the employee paying two percent, and the government paying the rest. UEBHI works by taking a percentage of a person’s wages and saving it into an individual medical savings account that is maintained by the Office of Human Resources and Social Security (Holtz, 2017). Children, students with severe disabilities, the elderly older than sixty years old, and the poor receive extra government subsidies to help pay for their healthcare. As for the residents in the rural area of China, they have what is called, the New Rural Cooperative Medical System (NRCMS) (Li, 2018). In two thousand and three, the healthcare coverage for rural residents was nine point five percent, which increased tremendously with ninty-eight point nine percent of the rural area covered by insurance. China has improved their payment systems over the years, but they continue to have a great amount of disease, illness, and limited income, which lead to many deaths annually. There are a lot of problems with Chinese healthcare, but there are numerous ways for a nurse to help fix the issues that a patient living in China may have.
One priority nursing diagnosis for China is deficient community health as evidenced by statistics of increased deaths of manageable or preventable injuries related to causative factors, such as insufficient healthcare funds, inadequate healthcare access, and inadequate overall living conditions. Other non-priority nursing diagnoses appropriate for China include knowledge deficit and readiness for enhanced health management. Deficiency in community health is defined as the “presence of one or more health problems or factors that deter wellness or increase the risk of health problems experienced by an aggregate” (Doenges, Moorhouse, & Murr, 2016). This diagnosis is most appropriate, as the many healthcare disparities in China have been explored. These disparities include ineffective healthcare access and funds, exposure to environmental toxins, such as indoor & outdoor pollution and unsafe water, lack of healthcare resources for the elderly and prenatal population, lack of training for the healthcare workers, and lack of system and order within health care.
With evaluating this nursing diagnosis, an appropriate short-term goal would be to identify causative and precipitating factors within this country. We are aware that not every healthcare disparity is preventable, or can be controlled by the people, but a good start would be helping these people identify the ones that are preventable. For example, appropriate interventions include spreading awareness or decreasing usage of coal and biomass fuel for indoor housing. This would decrease the risk of smoke exposure and lung damage. A good outcome for this goal would be for the country to have a reduction in preventable factors within one month, measured by statistics of decreased smoke exposure injuries, a decreased rate in comorbidities related to obesity or imbalanced nutrition.
The next short-term goal would be to assist the community in developing strategies to improve community function. An appropriate intervention would be to establish a leadership role who can delegate and allow the country to problem-solve as one, for effective solutions that work for everyone. For example, establishing networks, and resource aid programs within the country or even with other countries could greatly help. A good outcome for this goal would be to have strategies and plans in place to improve community function within three months.
The long-term goal would be to promote overall wellness within the country. This intervention would use the implemented knowledge and awareness gained and enforce the plan of development that was established. This plan may consist of an increased budget for healthcare facilities and systems, increased budget for training of healthcare workers, easier access to healthcare for everyone, alternative resource programs, or non-profit health care organizations. This goal would establish a proactive approach to planning for the future improvement of healthcare for the people. The goal’s outcome will be reflected by statistics, such as an increase in access to healthcare, a decrease in deadly illnesses and injuries in the elderly and prenatal, an increase in access to adequate water, and a decrease in overall exposure to air toxins within one year.
In conclusion, despite being a massive country, China has many shortcomings when it comes to healthcare. Pollution has had a huge effect on the health of the Chinese population. Various respiratory disorders, such as COPD, are more common due to a high amount of pollution. Lack of balance in quality of care between rural and urban areas can lead to unequal healthcare given throughout the country. Lastly, people who cannot afford healthcare do not receive it. This means that countless people in the country are not even receiving healthcare. These issues all play a role in why China’s healthcare system is much weaker than other developed countries’ healthcare systems.
References
- China Aims to Improve Child Healthcare, Education. (2015, January 16). Retrieved from ENGLISH.GOV.CN: http://english.gov.cn/policies/latest_releases/2015/01/18/content_281475040892445.htm
- Denyer, S., & Gowen, A. (2018, April 18th). Too Many Men. The Washington Post. Retrieved September 16th, 2018
- Holtz, C. (2017). Global Health Care: Issues And Policies (3rd ed.). Burlington, MA: Jones & Bartlett.
- Jotheeswaran, A. T. (2015). China Country Assessment Report On Ageing and Health. Geneva: World Health Organization.
- Lallanilla, M. (2013, March 15th). China’s Top 6 Environmental Concerns. Retrieved September 16th, 2018, from Live Science: https://www.livescience.com/27862-china-environmental-problems.html
- Li, H. C. (2018). Effectiveness evaluation of quota payment for specific diseases under global budget: a typical provider payment system reform in rural China. BMC Health Services Research, 1-12. doi:10.1186/s12913-018-3415-0
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